Patients with a poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle to mechanically raise a droopy eyelid Frontalis suspension procedure using a temporalis fascia or Tutoplast Dura was performed on 36 ptotic eyelids of 23 patients(age range 2-37 years) with a poor or absent levator function. The author used a surgical technique based on a modified Fox`s method. Satisfactory results were achieved in 42 lids according to the criteria of Jordan after an average follow-up of 23 months. No serious complication was seen immediately postoperative and during the follow-up period. Temporalis fascia and Tutoplast Dura appear to be effective and safe alternative sling materials for frontalis suspension surgery.
Blepharoptosis* ; Eyelids ; Fascia ; Follow-Up Studies ; Humans ; Jordan

The number of pressure ulcer patients is increasing owing to the aging population and increased incidence of elderly illness. This review article aims to introduce the current knowledge on the pathogenesis and prevention of pressure ulcers. The development of a pressure ulcer is associated with external factors such as pressure, shear stress, and friction and internal factors such as age, general condition, skin condition, and nutritional status. Pressure ulcers typically develop over bone protrusions, which are most pressured by weight, but may also be caused by external pressure by medical devices or other objects applied to the patient. This tissue damage is caused by continuous deformation of the tissue due to the pressure acting perpendicular to the tissue surface and shear stress acting parallel to the tissue, either alone or in combination. Limitation of activity and mobility, skin condition, blood circulation and oxygen saturation, nutrition, humidity, body temperature, age, low pain sensitivity, blood count, and general and mental conditions are the primary risk factors for pressure ulcers. A mattress and cushion that reduce pressure and an appropriate posture are necessary to prevent pressure ulcers. In patients with urinary incontinence, contaminated skin should be washed with a mild detergent and absorbent pads and topical protective agents should be used to protect the skin from moisture. Sufficient nutrition may help prevent wounds in patients who are susceptible to pressure ulcers. Furthermore, early screening, individualized management of posture, and regular skin and nutrition monitoring are essential to prevent pressure ulcers.

PURPOSE: The majority of nasal bone fractures have been managed by routine procedure of closed reduction, intranasal packing or intranasal Kirschner wire (K-wire) splinting. But it leaves rooms for many complaints from patients such as pain, rhinorrhea and nasal obstructioon. Another option is, of course, no packing at all. The study was initiated to assess the necessity to pack or splint the nasal bone after routine closed reduction. METHODS: We analysed the medical records of 35 patients with nasal bone fracture who were operated by closed reduction in the last 2 years. We evaluated the postoperative CT scan scores and external deviation criterias 1 month after the operation. RESULTS: The postoperative deviation criteria and postoperative CT scan score were favorable and there were no serious complications using this technique. CONCLUSION: The present study demonstrates that the use of packing or splinting need not be routine in the majority of cases. The risks and discomforts associated with these procedures can often be avoided.
Humans ; Medical Records ; Nasal Bone ; Splints

Macrostomia, also called a transverse or lateral facial cleft, is a relatively rare malformation. Although many surgical procedures have been introduced, and no gold standard has yet been established. Moreover, most papers published in Korea were based on the results of the research conducted on the very limited number of patients, and for this reason its findings do not offer sufficient clinical reliability. We devised a modified commissuroplasty as follows: First, new commissure was placed 1 or 2mm inside when compared with the opposite side so that the commissure may not look longer than usual because of the scar on the side. Second, z-plasty of about 5mm was performed on the nasolabial fold to prevent the displacement of the new commissure on its lower part and avoid a continuation of a scar with the medial flap placed upward. We treated 32 cases of macrostomia from August 1, 1998 to July 1, 2002. We obtained relatively satisfactory clinical results by using this modified commissuroplasty. Based on our experience, we intend to present a clinical analysis and an operation technique of our own derived from the classic commissuroplasty, so that we may contribute to the diagnosis and treatment of the patients in the future.
Cicatrix ; Diagnosis ; Humans ; Korea ; Macrostomia* ; Nasolabial Fold

PURPOSE: The objective of this study is to present a reliable method of scrotal reconstruction. METHODS: 75 year-old-man visited the out patient department of urology for chronic itching sensation in his scrotal area, diagnosed as Bowen's disease. After the wide resection of scrotal lesion, reconstruction was carried with pedicled anterolateral thigh perforator flap. All operation procedure was done with an usual manner, previously reported. Donor site was closed primarily. RESULTS: In 6th month follow-up period, there was no event, such as flap necrosis, wound dehiscence, tumor recurrence. And tactile sensation was recovered. CONCLUSION: In the Korean literature, there have not been the report that describes the reconstruction of scrotal defect using pedicled anterolateral thigh perforator flap. Pedicled anterolateral thigh perforator flap is reliable and robust flap for scrotal reconstruction.
Bowen's Disease ; Follow-Up Studies ; Humans ; Necrosis ; Perforator Flap ; Pruritus ; Recurrence ; Sensation ; Thigh ; Tissue Donors ; Urology

Nasal dermoid sinus cyst is a rare congenital lesion. It may present extracranially as a swelling or a mass on the nose, a skin pit or a sinus. Intracranial complications can be fatal including meningitis, abscess, osteomyelitis, seizures. The treatment of choice is complete surgical excision of the cyst. There are some approaches to this goal such as vertical midline incision, external rhinoplasty approach, bicoronal approach, and endoscopic approach. In this case, we could completely excise the nasal dermoid sinus cyst on the glabella without intracranial extension only with bicoronal incision.
Abscess ; Dermoid Cyst* ; Meningitis ; Nose ; Osteomyelitis ; Rhinoplasty ; Seizures ; Skin

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with utaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/*therapy ; Biopsy ; Humans ; Itraconazole/therapeutic use ; Male ; Middle Aged ; Skin Diseases/*surgery ; *Surgical Flaps ; Treatment Outcome

PURPOSE: The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula. RESULTS: The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula. CONCLUSION: We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.
Cutaneous Fistula ; Drainage ; Empyema ; Fistula ; Free Tissue Flaps ; Humans ; Lung ; Muscles ; Postoperative Complications ; Rectus Abdominis ; Thoracic Wall ; Thorax

PURPOSE: Traditionally, titanium miniplate has been used for rigid fixation of mandible fractures. However, the limitations of metal plate have been reported such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy, and so forth. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite of its lower strength. This study evaluated the usefulness and stability of biodegradable plate and screw for treatment of mandible fractures. METHODS: In this study, 61 patients(92 areas) diagnosed as mandible fracture in the last 2 years have been reviewed. We used titanium plate and screw in 32 patients, and biodegradable plate and screw(INION?) in 29 patients. Stability of plates and screws, bony healing process and its side effects were observed by clinical and radiographic assessment. RESULTS: In the titanium material group, one of malocclusion, two of mouth opening limitation, three of pain, three of palpation were shown. The plate of six patients involved in these complications were removed. In the biodegradable group, two of mouth opening limitation, two of pain, one of localized wound infection were shown and one plate was removed secondarily. CONCLUSION: There was no statistical difference between two groups in bony healing and complication rates. Biodegradable implants show efficient stability during initial bone healing and low side effects in long-term follow up periods.
Absorbable Implants ; Atrophy ; Bone Resorption ; Bony Callus ; Child ; Follow-Up Studies ; Foreign-Body Reaction ; Fracture Fixation ; Humans ; Hypersensitivity ; Malocclusion ; Mandible ; Mouth ; Palpation ; Titanium ; Wound Infection

PURPOSE: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. METHODS: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6mm projection. We applied tattooing in the areola area with micropigmentation device after three months. RESULTS: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1mm, compared with 2.8mm for the opposite nipple. CONCLUSION: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.
Cicatrix ; Congenital Abnormalities ; Extremities ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Mastectomy, Segmental ; Middle Aged ; Nipples* ; Skin ; Tattooing ; Tissue Donors